Attachment 4 - Experience Questionnaire.docx
DOCX document 24 KB Posted
- Attached to
- TSQ/CHE Road Maintenance RFQ (Amendment 01) Federal contract opportunity
- Solicitation number
- 12441923Q0116
- Issued by
- Department of Agriculture Forest Service
About this file
This document is an experience questionnaire for contractors interested in the TSQ/CHE Road Maintenance solicitation issued by the U.S. Department of Agriculture Forest Service. The questionnaire requests information on the contractor's experience, available equipment, rates of progress, planning and safety measures. Contractors are asked to provide details on past projects completed in the last three years such as contract numbers, award amounts, names and contact information of references, as well as percentage and dates completed. Current contract commitments and any past failures to complete work or work completed by bond are also to be disclosed. Equipment available for the project, including motorgraders owned or leased, sizes of dump trucks and their hauling capacities, and tools for culvert cleaning and ditch work must be specified. Minimum and maximum employee numbers and rates of progress for blading, ditching, culvert cleaning and spot surfacing are requested. Plans for concurrent project scheduling, site visit familiarity, and proposed safety measures are additionally to be described in the questionnaire.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| A09_12441923Q0116_Amendment 01.pdf | ||
| Attachment 6 - Detail Drawings.pdf | ||
| Attachment 7 - Daily Accomplishment Report.docx | DOCX document | |
| Attachment 3 - Maps.pdf | ||
| Attachment 8 - Performance Requirements Summary PRS.docx | DOCX document | |
| Attachment 1 - SOW.docx | DOCX document | |
| Attachment 2 - Schedule of Items_Price Schedule .docx | DOCX document | |
| 12441923Q0116_TSQ_CHE_Road Maintenance_RFQ.pdf | ||
| Attachment 5 - SCA Wage Determination 2015-4417.pdf | ||
| Attachment 9 - Performance Requirements Summary Definitions.doc | DOC document |
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Text version
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address, Telephone No. & Email
2. Type of Business ___Company ___Co-Partner ___Non-profit
___Corporation ___Individual
3. Howmany years experience do you have in this line of work? ____________Years
4. How many years experience as a Prime Contractor___________ Subcontractor____________
5. List the projects your business has completed in the last 3 years from the solicitation issuance date
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
7a. Have you ever failed to complete any work awarded to you? ____yes __ _no
7b. Has work ever been completed by performance bond? ___yes __ _no
7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: ____________ and Maximum # of employees: ______________
b. Are employees regularly on your payroll: ___yes __ _no
c. Specify equipment available for this contract:
1. Motorgrader:
Whay type of motorgrader is planned for this solicitation? _____________________________________________
Is this motorgrader owned, leased or subcontracted? __________________________________________________
What size of motorgrader? Please state the horsepower, weight and blade width. ___________________________
2. What type of equipment is going to be used to clean culverts and tail ditches? _____________________________
3. How many dump trucks will be used/obtained to support aggregate hauling and spreading operations to National Forest System Roads: __________________________________________________________________________
Are these dump trucks owned, leased or subcontracted? _______________________________________________
What size are these dump trucks? Please state the # of axles and hauling capacities in tons. __________________
d. Estimate rate of progress: (Miles per Day)
1. Blading: Minimum progress rate: ____________ Maximum progress rate: ____________
2. Ditching: Minimum progress rate: ____________ Maximum progress rate: ____________
3. Cleaning Culverts and Tail Ditches : Minimum progress rate: __________ Maximum progress rate: __________
Estimate rate of progress: (Tons per Day)
4. Spot Surfacing: Minimum progress rate: ______________ Maximum progress rate: ________________
e. Planning & Scheduling:
1. How do you intend to plan scheduling for other concurent projects listed in box 6.
f. Site Visit:
1. Have you visited the site and are you familiar with the work to be performed, condition of the roads, site accessibility, etc… to ensure succesful execution of all contract requirements at the quoted unit prices?
Please explain.
g. Safety & Traffic Control
1. Please explain the safety measures that you will put in place to ensure that site specific safety hazards have been considered adequate mitigation measures are in place for those hazards.
9. List the experience of the principal individuals of your business that will be used to perform this solicitation:
(Such as, motorgrader operator, other equipment operators, site superintendant, etc…)
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. REMARKS
CERTIFICATION: I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project:
Name:
| Title: |
| Date: |
File details come from the government source that posted it. Updated .